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Recognizing a Pandemic


We have seen how COVID-19, a disease spread by the novel coronavirus SARS-nCOV-2, has leapt into the limelight since its discovery at the end of 2019. In our blog posts we have discussed what COVID-19

We have seen how COVID-19, a disease spread by the novel coronavirus SARS-nCOV-2, has leapt into the limelight since its discovery at the end of 2019. In our blog posts we have discussed what COVID-19 is, how it spreads and why it is potentially dangerous. But we have not yet discussed what is being done about this disease. An epidemic in China, and at the cusp of being declared a pandemic, COVID-19 has whipped up countries and the populous into a frenzy. Many states have put quarantine measures in place, whilst ordinary people have resorted to using masks and other health measures (a topic we discussed in this BLOG POST). But have any of these measures had any effect? And could it cause more harm than good? Over the next few posts we will discuss the public health measures available for governments to implement and the rationale behind them.

COVID-19 is a respiratory disease propagated by SARS-nCOV-2 coronavirus. Current data suggests it has an incubation period of 2–14 days, during which the virus replicates inside its host, preferably in the lungs and upper respiratory tract. After this it causes respiratory tract symptoms, starting with fevers, coughing, sneezing and coryzal symptoms, but can develop into pneumonia or acute respiratory distress syndrome (ARDS). In some individuals this respiratory insult can lead to a critical state or even death. Despite its similarity to SARS and MERS, epidemics also caused by coronavirus, it has benefitted from a higher transmission rate and lower mortality rate. Furthermore its transmission can occur during its latent incubation period, and thus asymptomatic patients can help propagate the virus. These have been discussed at length in our previous topic of Viral Transmissibility.

ANOTHER PANDEMIC?

So how can we prevent an emerging disease from turning into a world ending pandemic? Strangely enough, recognition of the disease is the first step. In the 21st century our knowledge of infectious diseases grew exponentially, along with new vectors for fighting back. Antibiotics, vaccinations and innovative supportive treatment such as the iron lung turned previously lethal diseases into curable maladies. Prior to the introduction of its vaccine, a major measles epidemic occurred every 2–3 years leading to an estimated 2.6 million deaths each year. The global push for a vaccine between 2000–2018 has prevented an estimated 23.2 million deaths. Smallpox has been formally eradicated, with polio not far behind with 85% of infants across the world receiving three doses of the vaccine, preventing irreversible paralysis and respiratory arrest. Antibiotics have turned the tide on infectious diseases to such a degree that many experts stated it was “the time to close the book on the problem of infectious diseases” — a quote widely attributed to Jesse Steinfeld, US Surgeon General. Our current situation shows just how naïve we were.

Over the past 20 years the world has experienced multiple major outbreaks. SARS broke out in Asian countries in 2003, H1N1 in 2009, MERS in 2013, multiple Ebola epidemics in 2014 that in some cases continue to persist. Zika virus caused panic amongst expectant mothers around the world in 2015. Even the plague, an ancient disease commonly associated with the Dark Ages of Medieval Europe had 2,417 confirmed cases with 29 associated deaths in just Madagascar.

THE IMPORTANCE OF KNOWLEDGE

Knowing that the next major epidemic could be just round the corner is key in recognizing potential epidemics that may be developing. A key criticism in the management of SARS was the lack of transparency, poor response and communication from the Chinese government. This coronavirus based disease was first identified in the Guandong province of Southern China in November 2002, but the WHO was not notified until the end of March, by which time 792 cases and 31 deaths had been reported. By the end of the epidemic just over 8,000 cases and 774 deaths were reported.

In comparison the first potential cases of COVID-19 were identified in early December in Wuhan, China. By the end of the month a pneumonia of unknown cause had been reported to WHO China Office, with a possible link to the Huanan Seafood Market. Within 10 days the WHO had released guidance on the novel coronavirus with references to SARS and MERS, and in 12 China shared the whole genome sequencing of 2019-nCOV publicly. This measure encouraged research into the virus from an early stage, allowing comparisons to be made to SARS and MERS coronaviruses and also initiating development of specific diagnostic kits. Though there were reports of local health officials suppressing information from emerging on COVID-19 at the beginning of the epidemic, this was soon replaced with policies of openness and cooperation between different health governing bodies, national and international, and with other governments.

WHAT HAVE WE LEARNT?

It is arrogant to assume that our technological and scientific advances have lifted us out of the Dark Ages of pandemics and global calamities. In a time where information is freely available, disinformation campaigns have permeated through society. Alternative science groups such as the anti-vax movement and flat-earth theorists show how the availability of information is not enough, as people have developed a distrust against authorities and officials, relying instead on gut feelings and emotions. This creates new problems as unproven disinformation often spreads faster across social media than scientifically supported recommendations. During these times the key message to take away is often who to trust and believe.

Our recommendation is unwavering and absolute. Authorities such as the WHO are grounded in evidence based research and systematic approach. They provide unbiased, reliable information that can be trusted. In this short blog we have already seen what the WHO can achieve if an international effort is put in, and their advice is taken, both from the current COVID -19 recognition and from the efforts against previous pandemics. Following their recommendations provides the general public with the appropriate health measures to take, and the correct guidance on what to do if an infection is suspected.

In our next blog we will look at what happens after a potential epidemic is realized, and how public health measures are put in place to reduce the spread of the infection.

Dr Rajan Choudhary , UK

(WHO )